Upper extremity Flashcards
What is the overlying term of: scapula and clavicles connected to manubrium, connected only anteriorly to the axial skeleton via the sternum?
pectoral girdle
What are the four segments of the upper extremity?
shoulder, arm, forearm, hand
What two joints does the clavicle interact with?
sternoclavicular and acromioclavicular (helps w/ stability & motion of shoulder joint)
What is the passage between the neck and arm that provides protection for neovascular bundle supplying the upper limb?
cervicoaxillary canal
What is the most commonly fractured bone of the pectoral girdle?
clavicle – indirect force transmitted from an outstretched hand
weakest = middle and lateral thirds
What ligament prevents dislocation of the AC joint with a clavicle fracture?
coracoclavicular ligament
What ribs does the scapula overlie?
2-7
What is the purpose of the scapula?
- connects upper limb to trunk
- attachment for muscles
- stabilizes/assists shoulder
What provides the base from which the upper limb operates?
scapulothoracic joint
What’s between the tubercles for the attachment of the biceps brachii?
biciptal groove “intertubercular sulcus”
Where does the glenohumeral joint attach to the humerus?
anatomical neck
Where does the brachialis, pronator teres, and medial head of triceps brachii attach?
medial supracondylar ridge
Where does the triceps brachii, brachoradialis, and extensor radialis longus attach?
lateral supracondylar ridge
What nerve is in direct contact with the surgical neck?
axillary nerve
What nerve is in direct contact with the radial groove?
radial nerve
What nerve is in direct contact with the distal end of the humerus?
median nerve
What nerve is in direct contact with the medial epicondyle?
ulnar nerve
What’s the main stabilizing bone of the arm?
ulna
articulation w/ the humerus primarily allows flexion and extension of elbow joint
What runs obliquely between the radius and ulna to transmit forces recieved by the radius via the hand to the ulna and then to the humerus?
interosseous membrane
How many wrist bones are there?
8 in rows of 4
So Long to the Pinky, Here Comes the Thumb
Scaphoid - Lunate - Triquetrum - Pisiform, - Hamate - Capitate - Trapezoid - Trapezium
proximal to distal
going in a circle starting at pinky area
What forms the skeleton between the palm and carpus and phalanges?
metacarpus
What digit does NOT have 3 phalanges?
thumb
What fascia covers the deltopectoral groove where the cephalic vein travels?
pectoral fascia
What fascia encloses the pectoralis and subclavius and is pierced by the cephalic vein, thoracoacromial artery, and lateral pectoral nerve?
costocoracoid membrane
What fascia is attached to the clavicle, subclavius muscle, costocoracoid membrane, pectoralis minor muscle, continuous w/ axillary fascia, and the suspensory ligament of the axilla?
clavipectoral fascia
What fascia attaches to the spine of the scapula, the acromion process, and infraspinatus fascia as well as anteriorly, the clavicle, the pectoral fascia, and fascia of the arm?
deltoid fascia
What fascia encloses the arm and attaches to the epicondyles of the humerus and olecranon of the ulna and contains intermuscular septa?
brachial fascia
What are the two septas of the brachial fascia?
anterior (flexors) and posterior (extensors)
What does the antebrachial fascia thicken and form at the posterior ends of the radius and ulna?
extensor retinaculum
What does the antebrachial fascia thicken and form anteriorly?
palmar carpal ligament
What is the extensor retinaculum?
deep fascia over the wrist, does NOT attach to the ulna, and underneath: extensor digitorum, indicis, digiti minimi
What is the flexor retinaculum?
transverse carpal ligament – deeper and distal to extensor
Carpal tunnel - flexor tendons and median nerve pass through!
What are the boundaries of the carpal tunnel?
carpal bones and flexor retinaculum
What are the contents of the carpel tunnel?
nine tendons: flexor pollicis longus, 4 flexor digitorum superficialis, 4 flexor digitorum profundus
Where is most of the upper limb innervated?
brachial plexus - C5-T1
Where is most of the shoulder innervated?
cervical plexus C1-C4
What are the superficial veins of the arm?
axillary vein, cephalic vein, median cubital vein, basilic vein
What are the deep veins of the arm?
brachial, radial, ulnar, deep palmar venous arch, superficial venous arch
“venae comitantes”
What’s the lymphatic drainage of the arm?
subcutaneous tissue – superficial lymph nodes
bones and joint capsules – deep lymph nodes
What receives lymph from the anterior thoracic wall, most of the breast?
pectoral lymph nodes
What recieves lymph from the posterior thoracic wall and scapular region?
subscapular lymph nodes
What receives lymph from most of the upper limb?
humeral
What receives lymph from deep to the pec minor?
central
What receives lymph from all other groups and cephalic vein?
apical
What provides a passageway for neurovascular structures?
axilla
What does the axilla contain?
axilla artery, vein, tributaries, lymphatics, lymph nodes, brachial plexus, axillary sheath surrounding neovascular bundle
Where does the axillary artery end?
teres major
What are the 3 parts of the axillary artery?
1st - 1st rib and medial border of pectoralis minor (superior thoracic artery)
2nd - posterior to pec minor (thoracoacromial and lateral thoracic arteries)
3rd - lateral border of pec minor to inferior border of the teres major (subscapular, anterior circumflex humeral and posterior circumflex humeral)
What forms the axillary vein?
brachial vein and basilic vein union at the inferior border of the teres major, that ends at lateral border of 1st rib where it becomes the subclavian vein
What does the axillary vein receive drainage from?
thoracoepigastric veins with superficial veins from inguinal region with tributaries of axillary vein – collateral route that enables venous return in the presence of obstruction
Where is a central line placed?
subclavian vein as it crosses the 1st rib
What is the brachial plexus?
branches arise in axilla after it crossed the 1st rib, formed by union of anterior rami of C5-C8 and T1
Where do the brachial roots usually pass through?
between anterior and middle scalene with the subclavian artery – they unite to form three trunks
What are three trunks of the brachial plexus?
superior – union of C5 and C6
middle – continuation of C7
Inferior – union of C8 and T1
What unites to form the lateral cord of the brachial plexus?
superior and middle trunks
What does the anterior division of the inferior trunk continue as?
medial cord
What does the middle division and pieces of all three trunks unite to form?
posterior cord
What are muscles that receive motor innervation from a spinal nerve?
myotomes
What movement does C5 innervate?
lateral rotation, arm abduction, arm flexion
What movement does C6-C8?
arm extension, arm adduction, medial rotation
What movement does C5-C6 innervate?
elbow flexion
What movement does C6-C7 innervate?
elbow extension, wrist extension and flexion
What movement does C6 innervate?
supination
What does C7-C8 innervate?
pronation, digital flexion and extension
What does T1 innervate?
abduction and adduction of the fingers
What damage can be done with excess increase in the angle between the neck and the shoulder like being thrown from a motorcycle?
C5 and C6 tears roots of plexus – abducted shoulder, medially rotated, extended elbow
How does acute neuritis present?
sudden onset of pain, usually right shoulder, begins at night
What does prolonged hyperabduction during over the head manual tasks cause?
cord compression between coracoid process and pec, minor tendon. Pain radiating down the arm, tingling, weakness of the hand
What’s less common in cervical injuries?
inferior damage caused by sudden superior pulling, C8 and T1
What’s the main arterial supply to the arm?
brachial artery, continuation of the axillary artery -
begins at inferior border of teres major and ends in cubital fossa opposite neck of radius –> radial and ulnar
What’s the deep artery of the arm?
profunda brachii – largest branch that accompanies the radial nerve –> middle and radial collateral arteries
What are the two ulnar collateral arteries?
superior – middle of arm, accompanying ulnar nerve, anastamoses to form periarticular
inferior - below elbow crease
What nerve supplies the anterior compartment and injury results in paralysis of the coracobrachialis, biceps and brachialis with minimal action of brachioradialis and supinator?
musculocutaneous
What nerve supplies the posterior compartment with injury meaning paralysis of the triceps, brachioradialis, supinator, and extensor muscles of the wrist fingers with a wrist drop ?
radial
What nerve has no branches in the axilla or arm but supplies the articular branches to the elbow?
median
What nerve is vulnerable to injury, crazy bone, no branches in the arm, and supplies the articular branches to the elbow?
ulnar
What nerve supplies all of the posterior compartment and enters the forearm between the brachioradialis and brachialis with a superficial and deep branch?
radial
What has the terminal part of the brachial artery, radial and ulnar artery, deep veins, biceps brachii tendon, median nerve, and radial nerve, with the medial cubital vein?
cubital fossa
What four muscles move the pectoral girdle?
- pectoralis major
- pectoralis minor
- subclavius
- serratus anterior
What does the pectoralis major form with the deltoid?
deltopectoral groove where the cephalic vein runs
What are the two heads of the pectoralis major?
clavicular and sternocostal heads
Where does the pectoralis minor lie and some of its purpose?
anterior wall of axilla to stabilize the scapula and is used when reaching forward to touch an object, elevates ribs, and forms a bridge for vessels and nerves to pass to arm
Where is the subclavius?
inferior to the clavicle
What does the subclavius do?
protects subclavian vessels and helps resist clavicle dislocation at the AC joint
What is the serratus anterior?
strong muscle, called the boxer’s muscle and paralysis = injuries to the long thoracic nerve
What are the posterior muscles from superficial to deep?
trapezius & lats –> levator scapula & rhomboids –> deltoid, teres major, rotator cuff
What attaches the pectoral girdle to the trunk, cranium, and vertebral column?
trapezius
What adducts, medially rotates, and extends arm, and surgery places thoracodorsal nerve at risk – know there is an issue with upper limb climbing?
latissimus dorsi
What elevates the scapula and rotates, extends, and lateral flexion of the neck?
levator scapulae
What’s used when forcibly lowering the arms?
rhomboids
What muscles act on the glenohumeral joint?
deltoid, teres major, SITS
How do the anterior and posterior parts of the deltoid work?
anterior - flexes
posterior - extends
What is an important stabilizer of the humeral head in the glenoid cavity and adducts and medially rotates the arm?
teres major
What forms a musclotendinous rotator cuff around the glenohumeral joint and protects the joint?
SITS
How do you test the supraspinatus?
abduction of arm from fully adducted
What is the most common SITS tear?
subscapularis – biceps tendon also could be injured
What is partly covered by the deltoid and trapezius, rotates the humerus, stabilizes the glenohumeral joint?
infraspinatus
How do you test the infraspinatus?
person flexes the elbow and adducts the arm, arm is laterally rotated.
What is the elongated muscle hidden by the deltoid and works w/ infraspinatus to rotate the arm laterally and assist in adduction, and is supplied by the axillary nerve?
teres minor
How do you test the teres minor?
slightly abducts shoulders w/ elbows at 90 degrees, push arms outward with resistance and externally rotate
What forms part of the posterior wall of the axilla ad primary medial rotator of the arm and also adducts?
subscapularis
What is the subscapularis test?
dorsum of hand on back and lift hand away from back
What are the three flexors of the arm and the nerve it is supplied by?
biceps brachii, brachialis, coracobrachialis (musculocutaneous nerve)
What’s the extensor of the arm and the nerve it’s supplied by?
triceps brachii (radial nerve)
What lies posterior to the biceps, main flexor of the forearm, and the only pure flexor as the “workhouse” of elbow flexors?
brachialis
What is pierced by the musculocutaneous nerve and often used as a landmark with a distal part of its attachment indicating location of nutrient foramen of the humerus?
coracobrachialis
